Bryant Stamford | Special to the Courier Journal
Regular readers of my column know I have been very bullish about the Coronary Calcium Scan, also known as a calcium score test or coronary calcium score, as a test for heart disease risk. I take my lead from a cardiologist, Dr. Henry Sadlo, who has been championing this cause for several years.
CCS has been instrumental in saving many lives and yet another reader wrote in recently to tell me about their experience with the test.
Are Coronary Calcium Scans worth it?
"I was sitting at home watching TV with my wife when I felt a sharp pain in my chest. A short time later the pain also ran down my left arm at which point my wife told me I needed to get to the hospital," this reader wrote. "I did and they ran tests on me multiple times through the night, but couldn’t find anything wrong. Their conclusion was it must have been heartburn or gas."
"The information was plugged into my chart online and my personal [doctor] of many years saw it and called me, insisting that he see me immediately. When we met the next day, he told me he wasn't convinced there was nothing going on and that he had already arranged for me to take a CCS test," the reader continues. "I shrugged and agreed to keep the appointment, and thankfully I did. My CCS score was over 800, alarmingly high, and worse, there was an issue with the so-called 'widow-maker' artery. An appointment was made for the next day with a cardiologist. Two days later I had heart surgery with two stents."
The reader continued: "Had I not had a personal [doctor] who cared so much about my wellbeing and who knew the benefits of the CCS, there is a good chance I soon would have had a massive heart attack and not be writing this. I am deeply indebted to my doctor, and I thank you and Dr. Sadlo for beating the drum on this non-invasive procedure that saved my life."
How much does a Coronary Calcium Scan cost and is it covered by insurance?
Let me clear up some confusion, and concerns, about why the CCS is not covered by most health insurance.
It's typical for new tests to take quite a while before they are adopted for insurance payment. There are lots of reasons for this, including that new tests often mean additional expense, and it's a natural business decision to resist new expenses as long as possible until the evidence is overwhelming that certain tests should be covered as part of "basic" healthcare.
Out-of-pocket cost for the CCS varies but is approximately $100. The letter above, plus many testimonies from Sadlo's patients, make it quite clear, in my opinion, that it's money well spent.
What are the limitations of a Coronary Calcium Scan?
Another obstacle is that the CCS measures calcified plaque in the heart arteries. Plaque is first deposited in the arteries as a "mushy mass" of cholesterol and other debris. Over the years, calcium invades these mushy plaques, cementing them in place, thus the term "hardening of the arteries." The problem when considering results from a CCS is you could have substantial clogging in your arteries that is still in the mushy stage and would not be detected with a CCS.
In turn, this could provide a false sense of heart health with a CCS score of zero.
But even with this limitation, the CCS test is still an extremely valuable tool. What's more, virtually all tests have some limitations. For example, the blood pressure in my arm may be far different from the blood pressure in my ankle. If so, it could indicate severe vascular problems. So, does this mean it's not worthwhile to measure the blood pressure in my arm since it tells nothing about what is going on in my ankle? Or, does it mean this limitation is noted and additional steps should be taken? The answer is obvious.
Does resistance and strength training help reduce heart disease?
Throughout my 50-plus-year career, cardio exercise has been the emphasis when it comes to promoting cardiovascular health and prolonging life. Resistance training, which includes weightlifting, has always been an "add-on," meaning first you make sure you do your cardio exercise regularly according to established guidelines. This includes at least 150-300 minutes per week of moderate-intensity exercise (walking), or 75-150 minutes of vigorous-intensity exercise (jogging, cycling, swimming, elliptical, etc.). And then, toss in a couple of resistance training workouts to keep your muscles from deteriorating.
This is changing as resistance training is earning a new and improved status. Several recent studies, including one published by the "British Journal of Sports Medicine," on Sept. 27, tout the health benefits of resistance training, and a new large-scale study drives the point home. Nearly 100,000 subjects aged 55-74, males and females, were tracked by frequent surveys since 2006, and deaths from all causes (cancer, etc.) and also from heart disease (the number one killer) were recorded.
Exercise habits among subjects are typical of the American adult population with 23.6% meeting cardio guidelines, and 16% engaged in resistance training on a regular basis. Not surprisingly, those who exercise regularly had the lowest mortality risk. However, it was surprising that those who restricted their exercise to resistance training only demonstrated a significant 9% lower risk.
Is cardio exercise or strength training better to reduce heart disease?
Now, don't get me wrong. Cardio exercise is still king as those who reported regular cardio exercise had a 32% lower risk. However, and here is the punchline, for those who did both, cardio and resistance training regularly, mortality risk was lowered by a robust 41% when compared to sedentary subjects.
The benefits of cardio exercise are well known, but why resistance training helps reduce the risk of death from all causes, especially from heart disease is less clear. Jessica Gorzelitz, Ph.D., lead author of the study, speculates that resistance training improves overall health and heart health due to an increase in health-promoting muscle mass, and a decrease in body fat that imposes a huge toll on health. Gorzelitz also speculates that with resistance training, the unique demands on blood flow may promote cardiovascular adaptations that are beneficial throughout the entire body.
The bottom line when it comes to the impact of exercise to reduce mortality risk, especially from heart disease, you should include both cardio and resistance training for maximum benefit.
Reach Bryant Stamford, a professor of kinesiology and integrative physiology at Hanover College, at firstname.lastname@example.org.